Beaconsfield Medical Practice

Updated 22 July 2016

Beaconsfield Medical Practice offers general medical services to people living and working in Brighton.

The surgery has seven partner GPs (male and female) and one salaried GP. The practice is a training practice and had a GP registrar, foundation doctor and medical students placed with them at the time of our inspection. There are three practice nurses and three healthcare assistants, plus nursing students on placement and two phlebotomists. In addition the practice has a total of 21 administrative and reception staff. There are approximately 10,200 registered patients.

The practice is open between 8.00am to 6.00pm Monday to Friday. Between 6.00pm and 6.30pm telephone lines are open for emergencies. Appointments are from 8.00am to 6.00pm daily. Extended surgery hours are offered between 6.30pm and 8.00pm on a Monday and between 8.30am and 10.30am on a Saturday. Additional extended hours appointments are available through a local project, held at a neighbouring surgery between 6.30pm and 8.00pm weekdays and every between 8.00am and 2.00pm every Saturday and Sunday. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are also available for people that needed them.

The practice population has marginally higher than average proportion of elderly patient over the age of 85. They have a lower than average percentage of patients with a long term health condition and a lower than average proportion of patients who are unemployed.

The practice runs a number of services for its patients including asthma clinics, child immunisation clinics, diabetes clinics, new patient checks, and weight management support.

Services are provided from the main practice location at;

175 Preston Road,

Brighton,

BN1 6AG

The practice has opted out of providing Out of Hours services to their patients. There are arrangements for patients to access care from an Out of Hours provider (111).

Updated 22 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Beaconsfield Medical Practice on 16 February 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risk management was comprehensive, well embedded and recognised as the responsibility of all staff.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Data from the GP survey and the practice’s own internal survey was consistently high. This included access to appointments and the care they received. Patient feedback demonstrated that the practice was performing higher than average in a number of areas. In particular, where patients were able to see their preferred GP the practice scored 14% higher than the local average and 22% higher than the national average.
• The practice’s clinical and public health performance in relation to QOF was consistently high, with many areas scoring higher than the local and national areas. This meant that patients with long term conditions were being monitored appropriately.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand

• The practice had a clear vision which had quality and safety as its top priority.
• Feedback from patients was strongly positive and general satisfaction was high.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example they had implemented a privacy screen at the reception desk and had made changes to parking to make it easier for patients to park. Members of the patient participation group told us they felt valued by the practice and that the practice as a whole was proactive about gaining patient’s views.
• Data showed that the practice was performing highly when compared to practices nationally and in the Clinical Commissioning Group having achieved 100% in many of the QOF clinical domain indicator groups. Data showed that performance was higher than average for many long-term conditions. More patients with mental ill health had a comprehensive care plan documented in their record than the local average.
• The practice was involved in research trials and studies, the partners had written research publications and we saw that findings from audits had been used to improve services.
• Data from the National GP Patient Survey showed patients rated the practice higher than others for almost all aspects of care.

We saw the following areas of outstanding practice;

• The practice had both evening and weekend extended access appointments available for patients who were working during the day.
• Care for patients with long term conditions was consistently high and the practice had consistently achieved high QOF scores. Specific initiatives to support patients with long term conditions included customising templates to record review information, moving chronic obstructive pulmonary disease (COPD) reviews to the summer so that patients had standby treatment in advance of the winter months and running a virtual consultant led diabetic clinic for patients with poor control.
• There was a culture of research, teaching and the use of evidence-based practice to improve the quality of care for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 July 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Diabetes performance indicators were similar to both CCG and national averages. In 2015 the practice held a pilot community diabetes ‘virtual clinic’ with a consultant diabetologist from the local trust. This enabled them to review patients with poor diabetic control and provide additional support and treatment to those patients.
• Performance was higher than average for many long-term conditions. For example, the percentage of patients with COPD who had a flu immunisation was 91% which was 11.3% above CCG average and 9.5% above national average.
• The practice moved chronic obstructive pulmonary disease (COPD) reviews to the summer months so that patients had standby treatment in advance of the winter months.
• The practice used customised templates to record information consistently for patients with a long-term condition.
• Longer appointments and home visits were available when needed and patients we spoke with told us they were easily able to book a longer appointment if they needed to discuss more than one issue.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Single annual reviews were available for those patients who were on more than one disease register.

Updated 22 July 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• The practice provided medical support to a local community service and worked with multidisciplinary teams to ensure safeguarding activities and practices followed best practice. Regular monthly audits of safeguarding records ensured all safeguarding concerns were followed up.
• 71.5% of patients on the register with asthma had had a review in the last 12 months compared with 75.2% locally and 75.3% nationally. The practice were in the process of carrying out reviews of patients who had been taking high doses of asthma medicines as a result of a national review of asthma deaths identifying these patients as high risk.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• 85% of women aged 25 or over had received a cervical smear in the preceding five years compared to 82% of women nationally.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had a full range of contraceptive services available.
• We saw positive examples of joint working with other services. For example the practice had a visiting community midwife who ran a clinic at the practice every week and who met with the practice staff to share information about families identified as being vulnerable.

Updated 22 July 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Nursing staff were aware of their most vulnerable patients and we saw evidence of phone calls and follow up appointments for patients who required additional support.
• The practice worked closely with local nursing and care homes and had undertaken a project to reduce antibiotic prescribing for urinary tract infections for patients in nursing homes in line with new national guidance.

Updated 22 July 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• Extended hours appointments were available on a Monday evening and Saturday morning at the practice. In addition further extended hours appointments were available at a neighbouring practice every weekday evening and weekend morning for patients unable to attend during normal working hours. This was a part of a locally run project for patients in Brighton and Hove.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. Health promotion and screening was provided that reflected the needs of this age group. For example smoking cessation and weight management support
• The practice was participating in a pilot with the Sussex Musculoskeletal Partnership to help promote self-management for patients with musculoskeletal conditions.

Updated 22 July 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 78.9% of patients with mental ill health had a comprehensive care plan documented in their record. This was 11.2% above the local average and 1.7% above the national average.
• The dementia diagnosis rate was similar to local and national averages. The practice referred patients presenting with memory impairment to the Memory Assessment Service (MAS) and one of their GPs had a special interest and was a lead GP for MAS.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 July 2016

The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. They identified patients at risk of an unplanned admission to hospital and ensured they had a personalised care plan and annual review.

• The practice offered longer appointments for patients with a learning disability. Annual health checks were provided by the lead GP for learning disabilities and one of the practice nurses.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice provided GP services to a local women’s refuge and they liaised with key workers and the wider multidisciplinary team to ensure a coordinated care package was available for each woman and her family.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.